Lacrimal ductal cyst of the medial orbit: a case report

Abstract

Background The lacrimal ductal cyst (dacryops) is an uncommon clinical entity. It occurs anywhere that lacrimal gland tissue is present but most often appears as an expanding mass in the region of the lacrimal gland. The presence involving the medial part of the orbit is rare, ectopic location can be misleading in the differential diagnosis of orbital masses. The authors report a 53-year-old man who presented with dacryops occurred in an unusual location with significant clinical presentations. Case presentation A 53-year-old man had a painless mass located in the right superomedial orbit accompanied with foreign body sensation and lachrymation for two months, which had rapidly grown within 10 days. Decrease of visual acuity, high intraocular pressure (IOP) and limitation of extraocular movements in the right eye were present. The result of visual evoked potential (VEP) test suggested the impaired function of the optic nerve. Magnetic resonance imaging (MRI) studies revealed the presence of an isolated cystic lesion. The mass was completely removed via a transcutaneous approach, histopathologic findings were consistent with the lacrimal ductal cyst. The ocular motility and high IOP returned to normal. There had been no post-operative complications or signs of recurrence over five months follow-up. Conclusion Lacrimal ductal cysts can present in the medial orbit, clinicians should include this entity in the differential diagnosis of orbital masses and be aware of its variable presentations such as high IOP in this case. We comment on the fact that many reported cases of ectopic dacryops may be an extension of normal lacrimal gland tissue.

Giant Lacrimal Gland Cyst in a Pediatric Patient: Case Report and Review of the Literature

“…1,3 Prompt identification and treatment of these cysts is crucial to prevent chronic progression which may lead to malignant transformation, abscesses, fistulas, and secondary corneal ulcers. 20 The patient presented herein demonstrated frequent refractive changes and mechanical ptosis, which may have led to mild amblyopia from delayed identification and management. It is thus critical to consider this etiology and initiate expedited management in the pediatric population.…”

“…Lacrimal gland cysts typically present as unilateral, painless, mobile lesions that transilluminate on clinical examination 20 ; consequently, diagnosis is often based on these features. However, histopathology plays an important role to confirm the diagnosis as these cysts must be distinguished from dacryoadenitis, lacrimal gland tumors, lymphoid tumors, foreign body granulomas, sarcoidosis, dermolipomas, or lacrimal gland prolapse.…”

Cystic Lesions of the Orbit

“…86 Clinical Presentation Orbital lobe cysts generally develop in early childhood, while ectopic cysts can occur at any age. 10,82 Dacryops within the orbit typically present with symptoms of mass effect (proptosis, dystopia) that are gradually progressive. 10,82 Examples of the clinical appearance of dacyops are shown in Figures 6D and E.…”

“…10,82,83 Orbital lobe and intraorbital ectopic cysts are comparably rare and can be challenging to diagnose. 10,82 Though the exact etiology is unknown, factors which predispose to dacryops formation include longstanding conjunctival inflammation, traumatic or chemical injury, and Chlamydia trachomatis infection. 10 Pathogenesis is thought to involve several factors.…”

“…10,82 Dacryops within the orbit typically present with symptoms of mass effect (proptosis, dystopia) that are gradually progressive. 10,82 Examples of the clinical appearance of dacyops are shown in Figures 6D and E. They may also develop mechanical ptosis, restricted ocular movements, orbital inflammation, and visual changes such as diploplia.…”